Biomedicine and Society – New subjectivities in accordance with the thought of Michel Foucault?

I would like argue for that we face a change-over when we address the issue of biomedicine, neuroscience and society. Working from the concepts of biopolitics and biopower, the thought of Michel Foucault has been quite dominant when scholars within the cultural and social sciences have taken on the quest to elaborate upon the interaction between biomedicine and society. And even though Foucault suffered an all too early death in 1984, prominent and inspiring scholars have continued to produce interesting and productive accounts on the basis of the concepts developed by Foucault. The most well-known scholar in the “foucauldian” paradigm, and being an ongoing inspiration for me, is perhaps the English sociologist Nikolas Rose (see Rose 2007). Others who have utilized the thinking of Foucault include the American anthropologist Paul Rabinow, who termed the concept of biosociality which has been analyzed in earlier post in this blog (see Gibbon and Novas 2008). However, as the American anthropologist Margaret Lock points out, this paradigm, based as it is on the dual concept of power/knowledge, is now under some pressure when the “foucauldian” concepts meet the empirical reality of everyday life. According to Lock it is now:

Necessary to move beyond an assumption of an inevitable conflation of knowledge and power initially proposed by Michel Foucault to a position that highlights the agency and, above all else the heterogeneous responses to genetic technologies of individuals, families, and labeled populations (Lock and Nguyen 2010: 304).

But what are the problems that face us when we try to make sense of our empirical material through Foucault’s analytical schemata?

Power/knowledge

For those of you who are familiar with the assumptions put forward by Foucault, the awareness raised by Margaret Lock should be old news as the aspect of agency has been an issue that has been haunting Foucault ever since The Order of Things (2002) and his ongoing assurance of not being a structuralist (see Foucault 1997: 115). The form of power, according to Foucault, is something that:

Applies itself to immediate everyday life, categorize the individual, marks him by his own individuality, attaches him to his own identity, imposes a law of truth on him that he must recognize and others have to recognize in him. It is a form of power that makes individuals subjects. There are two meanings of the word “subject”: subject to someone else by control and dependence, and tied to his own identity by a conscience or self-knowledge. Both meanings suggest a form of power that subjugates and makes subject to (Foucault 1997: 331).

In my eyes this definition might be one of the best accounts given by Foucault on the relationship between “power/knowledge” as it implies the crucial role of knowledge and science in the way power is exercised in the modern society. Power does not act in an immediate form of action; it is rather to be understood as an “action upon action, on possible or actual future or present actions (Foucault 1997: 340). Moreover, power categorizes and imposes a law of truth on the individual, and this is the point where science steps in and forms its famous unification with power. Science occupies the “front-seat” in the various bids for reasons that are present in the modern society. Science constitutes the ultimate form of human reasoning which give science and scientific notions a crucial role in the way power is exercised in the modern society. Through science and scientific notion action can be taken upon actions in a very economical way without involving too much immediacy and manpower. The best way to illustrate this model is of course the allegory used by Foucault of Bentham´s Panopticum.

Power/Knowledge and biomedicine – present applications of Foucault

A good illustration on the account given in the former section is Nikolas Rose´s article “Neurochemical Selves” (Rose 2007: 187-223) in which Rose means that:

Over the past half century, we human beings have become somatic individuals, people who increasingly come to understand ourselves, speak about ourselves, and act upon ourselves –and others- as beings shaped by our biology. And this somaticization is beginning to extend to the way in which we understand variations in our thoughts, wishes, emotions and behavior, that is to say to our minds. While our desires, moods, and discontents might previously have been mapped onto a psychological space, they are now mapped upon the body itself, or one particular organ of the body –the brain. And this brain is itself understood in a particular register. In significant ways, I suggest, we have become “neurochemical selves” (Rose 2007: 188).

And further on in the text, Rose elaborates upon this new particular register that has replaced the old psychological understanding of ourselves:

The new style of thought in biological psychiatry not only establishes what counts as an explanation. it establish what there is to explain. The deep psychological space that opened in the twentieth century has flattened out. In this new account of personhood, psychiatry no longer distinguishes between organic and functional disorders. It no longer concerns itself with the mind or the psyche. Mind is simply what the brain does. And mental pathology is simply the behavioral consequence of an identifiable, and potentially correctable, error or anomaly in some of those elements now identified as aspects of that organic brain. This is a shift in human ontology –in the kinds of persons we take ourselves to be. It entails a new way of seeing, judging, and acting upon human normality and abnormality. It enables us to be governed in new ways. And it enables us to govern ourselves differently (Rose 2007: 192).

One can clearly see how many of Foucault´s basic assumptions about power constitutes the basis for the argument pursued by Rose in the citations above. The new knowledge produced by neuroscience implicates new, or different, forms of power relationships that concern the foundations of the way we come to reason and understand ourselves as citizens and humans. The production of new subjects and new subjectivities seems to be an intrinsic part of these developments, and something that are almost analytically predicted through the “foulcaudian” framework which draws so heavily on the combination between power/knowledge. But is this really the case?

What´s wrong with Michel Foucault?

The problem that seems to arise with the “Foucauldian” paradigm concerns the production of new forms of subjectivities, or rather how these subjectivities are produced. The underlining aspect is of course about the role of individual agency and if individuals take on new subjectivities in the wake of developments within neuroscience and biomedicine. As far as I can see, judging from some of the empirical investigations that have been carried out with ethnographic methods, the answer seems to somewhat negative, although more research is course needed before we can come to any coherent assumption. However, even in investigations carried out by Nikolas Rose and Carlos Novas, tensions that concerns the role of agency can be seen, and in their co-written article “Genetic risk and the birth of the somatic individual” (Novas and Rose 2000) they point towards a potential tension in relation to the unification between power/knowledge. In their empirical investigations that were carried out within the context of Huntington´s disease (HD), they found:

Little evidence that modern genetic biomedicine dreams of the reduction of the sick person to a passive body-machine that is merely to be the object of a dominating medical expertise. And, even if these dreams are dreamt, we can see that the genetic subjects that inhabit our contemporary complex and contested reality are very different. Genetic forms of thought have become intertwined within ethical problematizations of how to conduct one’s life, formulate objectives and plan for the future in relation to genetic risk. In these life strategies, genetic forms of personhood make productive alliances and combinations with forms of selfhood that construct the subject as autonomous, prudent, responsible and self-actualizing. And a new relation to expertise has developed, in which, at least for some, biomedical expertise is increasingly placed in the position of a resource to be drawn on in life planning, rather than as a master discourse in arbitrating forms of life or decisions as to procreation in the light of risk (Novas and Rose 2000: 597-508).

It seems like the notion of agency has to be acknowledged in a different form than proposed by Foucault. Far from being disciplined and subjugated through power relationships, the affected individuals in Novas´ and Rose´s investigation seems to be autonomous and taking on a relationship to the medical expertise which are not marked by dependence and control. For me the findings by Novas and Rose also seem to contradict Rose´s argument in relation to new forms of “neurochemical” subjectivities. This contradictory picture is also present in Margaret Lock´s investigations in relation to susceptibility for certain forms of Alazheimer´s disease (AD). Basing her argument upon the responses given by individuals who had gone through genetic testing for certain gene combinations that might indicate that you have a higher rate of susceptibility for developing certain forms of AD, she concludes that:

Little if any significant changes take place with respect to their sense of identity or subjectivity as a result of their testing. Individuals do not apparently adopt genetically informed identities, nor believe their futures to be profoundly changed from what they had already envisioned, but rather hold firm to ideas already internalized about heredity and the power of phenotypic resemblances (Lock 2008: 72).

It has to be stated that we are dealing with two different kinds of patterns of inheritance regarding the two diseases. HD has a strong biological causality, where each child of an affected parent has a 50% risk of inheriting the gene that causes HD. Moreover, HD is caused by one mutated gene which have a 100% penetrance (if you have the gene, you will sooner or later develop the disease), whereas the susceptibility genes that are involved in certain forms of AD are more than one, and even if you have the combination that puts you at risk, there is not a 100% penetrance which means that there is not the same inevitability present as within HD. However, these investigations, performed within two different contexts, points towards situation where the affected individuals do display a active and dynamic agency in relation to both the medical knowledge and the medical/scientific expertise. According to me, this is not coherent with the notion and workings of power defined by Foucault and by Rose in relation to us becoming “neurochemical selves” in the wake of new developments within neuroscience. The issue is far to complex to be acknowledged and visualized through the paradigm of Michel Foucault, and new initiatives are needed to account for the tensions described in this text. One alternative to Foucault comes in the form of Habermas´ theory of communicative action, which will be the subject for the next blog-post.

References

Foucault, M. (2002). The Order of Things. London: Routledge.
Foucault, M. (1997). “Truth and power”. In Rabinow, P. (ed.) Power –Essential Works of Foucault Vol. III. New York: The New Press.
Foucault, M. (1997). “The subject and power”. In Rabinow, P. (ed.) Power –Essential Works of Foucault Vol. III. New York: The New Press.
Gibbon, S. and Novas, C. Biosocialities, Genetics and the Social Sciences. London: Routledge.
Lock, M. and Nguyen, K-V. (2010). An Anthropology of Biomedicine. Malden MA: Wiley-Blackwell.
Lock, M. (2008) “Biosociality and susceptibility genes” in Gibbon, S. and Novas, C. (eds.) Biosocialities, Genetics and the Social Sciences. London: Routledge.
Novas, C. and Rose, N. (2000). “Genetic risk and the birth of the somatic individual”, Economy and Society, 29, 4: 485-513.
Rose, N. (2007). The Politics of Life Itself. Princeton: Princeton University Press.